Get In 55940 2019-2025

This guide provides step-by-step instructions for completing the IN 55940 form online. Designed for clarity, this resource aims to support individuals as they navigate the application process for Recovery Works.

Follow the steps to successfully complete the IN 55940 form.

1. Press the ‘Get Form’ button to access the IN 55940 form and open it in your preferred online editor.
2. Verify the eligibility requirements by checking all applicable boxes. Ensure that the participant is a resident of Indiana, at least eighteen years old, has a taxable income that does not exceed 200% of the federal poverty level, and has entered the criminal justice system with a felony charge or prior felony conviction.
3. Affirm the verification of eligibility by signing in the designated area. Provide the date and print the name of the referring criminal justice provider.
4. Fill in the participant's name in the specified area and acknowledge understanding regarding the referral to Recovery Works. Ensure to mention any previous involvement with Recovery Works to assist in planning the referral.
5. Enter the name of the Recovery Works agency and provide their telephone number. Indicate whether information has been sent to the Recovery Works agency by checking 'Yes' or 'No'.
6. Note any understanding or arrangement regarding the referral agency’s capability to meet the participant's needs, and describe steps to select a new provider if necessary.
7. Authorize the referral agency to release the participant's information by providing the name of the referring CJP agency, the email of the referring agent, their name, and telephone number.
8. Provide the participant's address, date of birth, and telephone numbers, including home, cell, and work, in the designated fields.
9. If applicable, fill in the date of release from incarceration and add any relevant comments in the comments section.
10. Finally, review all filled sections for accuracy. Save any changes, and opt to download, print, or share the completed IN 55940 form as needed.

Complete your documents online today to ensure timely processing of your Recovery Works referral.